MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 1124
Change Report (if Any):

Short Name: CN FAM/CHL TAYL

Long Name 1: CENTER FOR FAMILIES AND
Long Name 2: CHILDREN RAPART CENTER

Address 1: 1941 SOUTH TAYLOR ROAD
Address 2:

City: CLEVELAND HEIGHTS
Zip Code: 44118
County: CUYA

Contact: ANN HOLT WIOLLAND
Title: CFO
Phone: 2169329497
FAX: 2167327252

Vendor: 8227

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 12/21/2011

File Produced: 14JUL2016